| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $18.62 | $18.62 | $18.62 | |
Aetna
| Professional | $18.62 | $18.62 | $20.48 | |
CareSource
| Facility | $10.65 | $10.65 | $15.98 | |
Cigna
| Facility | $17.52 | $17.52 | $85.00 | |
Cigna
| Professional | $17.52 | $17.52 | $57.70 | |
United
| Professional | $18.62 | $18.62 | $23.78 |